Case SeriesThe Ecuador Pediatric Spine Deformity Surgery Program: An SRS-GOP Site, 2008–2016
Introduction
The Scoliosis Research Society Global Outreach Mission Programs (SRS-GOP) are medical missions endorsed by the Scoliosis Research Society (SRS) to provide spinal deformity care for children in low- and middle-income countries (LMICs). Although there are currently 20 approved sites, reported studies from these sites [1], [2], [3], [4] are scarce, with limited published patient outcomes. In general, very few studies have analyzed the tangible impact of global surgical missions.
The Project Perfect World (PPW) Spine Program in Guayaquil, Ecuador, developed from the PPW Foundation established in the early 1980s. Since 2002, PPW has been developing a pediatric orthopedic program with the Roberto Gilbert Elizalde Children’s Hospital, Guayaquil, Ecuador. Early in this program, the hospital staff and administration identified spinal deformity as an unmet need with high priority as there was no organized program in coastal Ecuador to care for many underserved children with a spinal deformity. The program was identified by the SRS Global Outreach Committee as a site that should be further developed.
After several years of building local relations and infrastructure under the general pediatric orthopedic program, we then began to initiate the spine component. During the 2006 and 2007 trips, the team began seeing patients with spinal deformity in anticipation for a 2008 pilot trip. The program started performing spine surgery in 2008 with week-long trips that take place annually. Fig. 1 depicts a timeline of the spine program’s progression. The purpose of this study is to 1) describe the development of the spinal deformity program in Guayaquil, Ecuador, including its establishment, growth, and obstacles; 2) assess the surgical outcomes, including health-related quality of life (HRQOL), radiographic measures, and complications; and 3) briefly explore predictors for HRQOL outcomes.
Section snippets
Setting
All operations were performed at the same institution, Roberto Gilbert Elizalde Children’s Hospital in Guayaquil, Ecuador, which has full operating room (Fig. 2), intensive care unit (ICU), radiology, anesthesia, pharmacy, and blood bank capacity. The Ecuadorian orthopedic staff identify and prescreen patients with spinal deformity and help coordinate the patients’ clinic appointments during our trip. At the start of each trip, our team evaluates all patients considered for spine surgery, and
Descriptive variables
Between May 2008 and May 2015, eight trips were completed with a mean time of six days on site and two to three spine surgeons per trip. A total of 42 spine deformity surgeries were performed on 38 patients during this period. Of the 38 patients who underwent surgery, 28 (74%) returned to clinic in May 2016 and 2017 for evaluation and are included in this study. Ten patients were excluded due to inadequate length of follow-up length or inability to present for evaluation during the 2016 and
Discussion
The development of regional, self-sufficient spine centers to provide care to children in LMICs is a primary goal of SRS-GOPs. Our program demonstrates that this can be achieved for spinal deformities; however, it requires strategic planning and sustained investment in local relationships and infrastructure. Such planning has involved a cooperative effort with the Ecuadorian staff and US volunteers who together provide supplies, nursing, clinic scheduling, patient care coordination, anesthesia,
Acknowledgments
Project Perfect World, Damien House under the leadership of Annie Credidio, Medtronics Foundation, First Hands Foundation/Cerner, Stryker, MTF Musculoskeletal Transplant/Tissue Foundation, Globus Relief international, AHRMM (Association for Healthcare Resource & Materials Management), Midwestern Medical, Orthopediatrics, DePuy-Synthes, Hanger Orthotics, Z-Medica Corporation, Advance Neural Stimulation, Lifenet Health, Abbot laboratories.
The above sources provided funding, donations, and/or
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Cited by (3)
Development of a Global Pediatric Orthopedic Outreach Program in Ecuador Through Project Perfect World: Past, Present, and Future Directions
2020, Orthopedic Clinics of North AmericaCitation Excerpt :As a result of a strong commitment from all stakeholders involved with the project, we have recognized many additional benefits and started numerous other programs. These include a new orthotics building and training program; Ponseti treatment program that is run by the Ecuadorian staff; 10 years of a successful spinal deformity program20; safe, sterile processing for the entire hospital; the hiring of 2 spine surgeons at the hospital; collaboration with the intensive care unit, rehabilitation, and physical therapy programs; an exchange program with neurosurgery; and the mentoring and training of a generation of medical students and residents. Despite many wins, there remain serious challenges.
PRESENTATION OF THE MULTICENTRIC COLLECTION SPINE SURGERY DATABASE
2022, Coluna/ Columna
Author disclosures: ANF (none), RMS (nonfinancial support from Medtronic, outside the submitted work; and President, Pediatric Orthopaedic Society North America; Past Chair, American Academy of Orthopaedic Surgeons, Section on Orthopaedics).
IRB approval: IRB approval was obtained for this work.